tbuckley/cabot-search huggingface dataset:
Evaluation of patient decision aid for opportunistic salpingectomy and salpingectomy as sterilization method to prevent ovarian cancer.
Authors: Malou Gelderblom, Jurgen M.J. Piek, J Briet, Lauren Bullens, Sjors Coppus, Inge Ebisch, Alexandra van Ginkel, Rafli van de Laar, Natascha de Lange, Huy Ngo, Marloes Maassen, Angele Oei, Brenda Pijlman, Brigitte Slangen, Dineke Smedts, M.Caroline Vos, Joanne De Hullu, Rosella Hermens
Journal: Journal of Clinical Oncology (2022)

379 Background: The fallopian tubes play an important role in the pathogenesis of epithelial ovarian cancer. This has led to recommendations for performing bilateral salpingectomy as primary prevention of ovarian cancer, the opportunistic salpingectomy (OS). OS has gained territory globally, however with unwanted practice variation. Since all women have the right to be informed on OS, a patient decision aid (PtDA) on OS and salpingectomy as sterilization method has been developed to provide uniform counseling and reduce this practice variation. The aim of this study was to evaluate the effect of the PtDA on the decision-making process. Methods: As part of the STOPOVCA-implementation-study we conducted a multicenter observational prospective study between July 2020 until now. Women who were eligible for OS were invited to use the PtDA while they considered whether or not to undergo OS during gynecological surgery. Evaluation was performed using digital questionnaires regarding their decision, the decision process, and the PtDA. Preliminary. Results: In total 84 women participated to the questionnaire of which 71 used the PtDA. The majority chose to undergo OS (90%). Main reasons for women choosing OS were the risk reducing effect of ovarian cancer and the unnecessary preservation of the fallopian tubes after childbearing. After using the PtDA, from patients perspective the extent to which they were involved in the decision-making process was high, and the decisional conflict low. Patients thought it is a usable aid and recommend other women who face the decision regarding OS to use it with an 8.4 out of 10. Conclusions: The PtDA supports the decision-making on whether or not to undergo OS among patients who have completed childbearing and undergo abdominal gynecological surgery.
Prevention and management of cetuximab-related hypomagnesemia.
Authors: Sabine Tejpar, Hiroya Taniguchi, Agustín Falco, Erica Velthuis, Christian Valencia Pineda, Ricard Mesia
Journal: Journal of Clinical Oncology (2022)

321 Background: Cetuximab is an epidermal growth factor receptor monoclonal antibody indicated for the treatment of squamous cell carcinoma of the head and neck and RAS wild-type metastatic colorectal cancer. Hypomagnesemia is a reversible adverse event associated with cetuximab treatment. Here, we provide the key considerations in prevention and management of cetuximab-related hypomagnesemia events in clinical practice. Methods: A PubMed literature search was conducted for articles published between 18 March 2012 and 18 March 2022 using cetuximab and hypomagnesemia as keywords. Of the 75 articles retrieved, 20 were considered relevant and are included here.Articles were excluded if they focused on hypomagnesemia-associated clinical benefits. Data were summarized and grouped into the following categories: risk and risk factors; monitoring; prevention; and management. Results: The relative risk of grade 3/4 hypomagnesemia following cetuximab therapy appears to be approximately 1.5 times higher for colorectal cancer compared with head and neck cancer. Several risk factors have been identified including age, comorbidities, treatment duration, baseline electrolyte levels, concomitant platinum-based chemotherapy, and polypharmacy. Although the frequencies of hypomagnesemia events vary between the studies identified, data from the included meta-analyses suggest that the incidence of grade 3/4 hypomagnesemia is around 4% among patients receiving cetuximab therapy. Early and regular monitoring of magnesium levels is recommended ideally every 4 to 8 weeks, especially in patients at high risk of serious complications, and up to 8 weeks following treatment cessation. Proposed proactive prophylactic interventions include magnesium supplementation for patients with baseline magnesium levels &lt; 1.8 mg/dL, to prevent severe hypomagnesemia. The management approach depends on the degree of hypomagnesemia, the symptoms and risk factors, and may include supplementation with oral magnesium salts and/or parenteral forms; intravenous forms may be preferred due to low bioavailability and gastrointestinal adverse events related to oral supplements. While recommendations for initiating magnesium replacement in grade 1 (&gt; 1.2 mg/dL) and grade 2 (0.91.2 mg/dL) hypomagnesemia events vary, magnesium supplementation should be given to patients with grade 3 (0.70.9 mg/dL) or grade 4 (&lt; 0.7 mg/dL) hypomagnesemia, due to high risk of serious adverse cardiac events. If magnesium levels do not improve or continue to decrease despite supplementation, a pause in cetuximab administration may be considered. Conclusions: Hypomagnesemia is a reversible and manageable cetuximab-related adverse event and should not interfere with treatment outcomes. A periodic check of magnesium levels during treatment with cetuximab is recommended.
Comorbidities among patients with breast cancer during COVID-19: Agreement between patient-reported data and electronic medical records.
Authors: Martine C. Maculaitis, Xianchen Liu, Jeffrey A. Thompson, Alexandra Berk, Angelina Massa, Marisa C. Weiss, Benjamin Li, Samantha K. Kurosky, Lynn McRoy
Journal: Journal of Clinical Oncology (2022)

409 Background: Comorbidities are a major cause of complications in cancer patients and can increase the risk of severe illness from coronavirus disease 2019 (COV). Yet, in real-world studies of cancer patients, comorbidities are often not well captured in electronic medical records (EMR); self-reported comorbidities may be limited by recall error. Combining and comparing self-reported and EMR data may help identify key data gaps in comorbidity diagnosis. We aimed to estimate self-reported and EMR-documented comorbidities and examine agreement between these data sources in US patients with early-stage (eBC) or metastatic (mBC) breast cancer. Methods: From March 30 to July 6, 2021, patients (aged ≥18 years) who self-reported a BC diagnosis (no current Stage 0 or ductal carcinoma in situ) and provided consent were recruited via Ciitizen, a patient-mediated health records and real-world evidence platform, and patient advocacy groups to complete a cross-sectional online survey. EMR data from Invitaes Ciitizen platform, covering November 1, 2019-September 28, 2021, were collected. The datasets were then linked; in preliminary assessment, depression (DEP), anxiety (ANX), and COV were the only comorbidities sufficiently populated to enable agreement analysis. DEP, ANX, and COV prevalence rates in EMR and survey data were computed. Agreement between data sources was estimated using Cohens kappa. Results: Overall, 542 patients in the linked sample were included in the analyses. A majority was female (99%), aged ≥50 years (52%), and diagnosed with mBC (53%). Patients were similarly distributed by US geographic region. DEP, ANX, and COV prevalence rates were 40%, 50%, and 6% in EMR and 20%, 16% and 10% in survey, respectively (Table). The kappa values for agreement were.5 (DEP),.3 (ANX), and.8 (COV). Conclusions: Mental health conditions and COV were prevalent in BC patients during the pandemic. It is important for oncologists to consider that DEP and ANX are often underreported among patients with BC. Agreement between data sources was low for mental health conditions. Self-report and EMR data may thus provide complementary information on comorbidities.[Table: see text]
Implementation of a scalable integrative oncology (IO) program in a large community oncology network.
Authors: Mary Darden, B. Stephens Dudley, Anne Laura Reviere, Stephen Matthew Schleicher, L. Johnetta Blakely, Larry Edward Bilbrey, Natalie R. Dickson
Journal: Journal of Clinical Oncology (2022)

215 Background: Integrative Oncology (IO) has become a specialized area of cancer care because of patient desire for holistic approach to care and in response to unmet symptom burden. Until now most IO programs have been limited to large academic medical centers. At Tennessee Oncology (TO), a large community oncology program spanning over 30 clinical sites of care throughout Tennessee and Georgia, an IO program was developed and implemented to bring IO to patients in the community. Methods: In June 2021, the IO program was launched with a physician and a nurse practitioner, both trained in Integrative Oncology. The program started at 8 clinics with visits primarily performed through telemedicine to allow access to each clinic. Providers were educated via email communication and a short video describing the program. Patient education was provided through our website and flyers placed in clinics. A referral order was created within the electronic health record. Results: Within one year, the IO program grew from seeing less than 20 patients per month to seeing over 100 patients per month. To date we have provided approximately 1,050 IO visits for 432 unique patients. Of these patients, 362 (83%) were female and 70 were male. The average age was 59 years old. The top three associated malignancies for patients were breast (n = 182), colorectal (n = 30), and gynecologic oncology (n = 29). Our IO program has expanded from eight to 16 clinics during this time frame. 75% of visits were provided through telemedicine. The most common reasons for IO referral were nutrition and symptom management (fatigue, neuropathy, etc). Conclusions: Implementation of an IO program is possible and scalable in a large community oncology setting. Future directions include studying the impact of our program on patient experience and overall health and wellness.
I-DO GOC: Improving documentation in oncology with goals of care.
Authors: Francisco Martinez, Karen Hauser, Ashley Aller, Aida Shirazi, Amy Ying Ju Lin, Peggy T Lim, Tyler Jones, Hannah Whitehead, Amita Risbud, Sue May Yen, Raymond Liu, Jed Abraham Katzel
Journal: Journal of Clinical Oncology (2022)

314 Background: Goals of Care (GOC) discussions are part of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early GOC discussions are associated with better quality of life, reduced use of futile medical care, and enhanced goal-concordant care. In order to increase GOC documentation within the electronic medical record (EMR), the Kaiser Permanente San Francisco medical oncology practice began an ASCO Quality Training Program initiative in January 2022 to increase oncologist discussion and documentation of GOC in advanced cancer patients. Methods: Baseline data on the frequency of GOC discussions was obtained through a structured chart review with a historical cohort of stage IV or recurrent cancer patients &gt; 18 years old between 1/1/2020-6/1/2020. The project aimed to improve accessible GOC documentation from a baseline of 0% to a goal of 25% among stage IV or recurrent cancer patients seen by an oncologist between 1/2022 and 5/14/2022. Patients with hematologic malignancies were excluded. Oncologists were instructed to use a templated GOC automated phrase (Smartphrase) that consolidated content into a visible, centralized EMR location. The frequency of GOC Smartphrase usage among oncologists was tracked monthly through a customized dashboard. Plan-Do-Study-Act cycles included education on GOC documentation and monthly feedback for oncologists on performance. Results: Review of the 2020 historical cohort revealed no structured or accessible GOC documentation by oncologists. During the intervention period, 300 Stage IV and recurrent cancer patients were eligible for GOC documentation. The median age of the intervention group was 70 years, with the most common types of cancers represented: Prostate (21%), Breast (19%), and Lung (17%). Our study cohort included a diverse population: White (45%), Asian (36%), Black/African American (11%), and Hispanic (7%). Between 1/1/2022 to 5/14/22, 142 (47%) patients had at least one documented GOC conversation, exceeding the target of 25%. 100% of these structured conversations were viewable in the designated area in the EMR. Conclusions: Our ASCO Quality Training Program initiative successfully increased oncologists' overall number of GOC conversations and made those conversations more easily accessible to the entire care team. Our process for standardizing the documentation of GOC conversations was based on the use of a Smartphrase that helped organize the collected information within the EMR. During the study period, we increased the documented GOC rate from 0% to 47%. This can improve patient and physician satisfaction, as well as improve goal concordant care for patients with advanced cancer. Further efforts will be focused on sustaining these initial gains in GOC documentation and on promoting their broader use across our organization.
Goals-of-care and serious illness conversations for patients with cancer with inpatient mortality.
Authors: Julie Jiyun Lee, Margaret Wheless, Henry Domenico, Barbara Martin, Marc Bennett, Jennifer Kiser Green, Rajiv Agarwal
Journal: Journal of Clinical Oncology (2022)

184 Background: Goals-of-care (GOC) and serious illness conversations are an integral part of personalized cancer care, particularly toward the end of life (EOL). Eliciting patients (pts)’ preferences and values facilitates informed decision-making throughout the disease course and enables oncologists to provide patient-centered care. Many aspects of GOC discussions and advance care planning (ACP) are inadequately understood, particularly during transitions of care when pts are hospitalized. Methods: We administered surveys to inpatient and outpatient medical oncologists of pts who died while hospitalized from 5/1/2020 to 5/31/2021. Survey items included oncologists’ knowledge of inpatient death, anticipation of pt death within six months of admission, recollection of GOC discussions taking place, and perceived barriers to GOC discussions. To better characterize EOL planning for these pts, retrospective data was collected to identify documentation of GOC discussions, advance directives, and hospice consideration in pts’ electronic health records. Results: For 75 cancer pts who died while hospitalized, 158 surveys were electronically administered with 104 responses (response rate: 66%). Pts characteristics: median age 62 (range 25-89); 63% men; 79% white; median length of hospital stay 7 days (range 1-45). Primary cancer disease type varied: 26.7% gastrointestinal, 18.7% non-small cell lung, 14.7% hematologic, 10.7% sarcoma, 9.3% genitourinary, and 19.9% other cancers. Of 104 completed surveys, responses were received from 40 inpatient and 64 outpatient oncologists. 81 oncologists (77.9%) were aware of the pt’s death prior to survey communication, 68 (65.4%) anticipated the pt’s death within six months of admission, and 67 (64.4%) recalled having a GOC discussion prior to or during the terminal hospitalization. Only 21.3% of pts had documented GOC discussions prior to admission, 33.3% had advance directives, and 22.7% had prior documentation of hospice consideration. Oncologist-reported barriers to GOC discussions included unrealistic expectations from pts or family (25%) and inability for pts to participate due to their clinical condition (15%). Oncologists commented on lack of time, lack of communication between inpatient and outpatient teams, and discordance among multiple inpatient providers as additional barriers. Conclusions: Most oncologists recalled having GOC discussions and anticipated six-month mortality for cancer pts who died while hospitalized. However, documentation of ACP and serious illness communication remained sub-optimal. Ongoing analyses are examining potential associations between patient, provider, and patient-provider relationship factors and oncologists’ survey responses. Addressing barriers to serious illness conversations across different healthcare settings is crucial to providing high-quality EOL care for cancer pts.
Implementation of a streamlined prior authorization process to improve clinician wellness and cancer care delivery.
Authors: Aarti Sonia Bhardwaj, Sofya Pintova, Mark Liu, Alana Noble-Kirk, Peter Blunck, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2022)

428 Background: Prior authorizations (PAs) for chemotherapy are increasingly becoming a barrier to timely and quality care delivery for cancer patients. There is an extraordinary administrative burden placed on clinical teams to participate in peer to peers (P2P) and file appeals when authorization specialists are unable to efficiently find the necessary clinical data in the EHR. 1 This leads to delays in care, staff burnout driven by decreased job satisfaction, loss of revenue from decreased clinician productivity and from chemotherapy given emergently but not retroactively reimbursed. 2 In partnership with the cancer registry team and Epic, we propose a workflow that shifts the clerical work required for PAs from the clinical teams to the certified tumor registrars (CTRs) using smart form optimization so the finance team has all the required information in one place to successfully and efficiently process the PAs. Methods: A list of common data elements including performance status, cancer biomarkers, line of treatment, goals of treatment and stage were identified. We are leveraging the staging smart form in EPIC to auto-populate these elements when available and then use CTRs to enter cancer stage, fill in any gaps and validate the data. Once approved by the CTR, the chemotherapy plan will be available in the authorization work queue for efficient processing. In 2020, we had 1,389 chemotherapy plans entered and about 38% of these required clinical intervention for financial clearance. We will track the number of P2Ps being conducted post-implementation and compare this to numbers prior to implementation. We will use descriptive statistics and t-test to compare these values. We are anticipating a 25% decrease in P2Ps. We will survey oncology physicians in June 2022 to measure baseline perceived physician impact of PAs and burnout and then again in January 2023 to measure the impact post-implementation. Results: A wellness survey was administered to Medical Oncology faculty within the Mount Sinai Health System pre-pandemic in 2020 and in 2021 and among respondents, approximately 1/3 have moderate to severe burnout risk pre- and post-pandemic. Coordination of care and PAs were rated as the largest barriers to wellbeing, and this increased from 43% pre- to 71% post-pandemic indicating a significant area of opportunity to improve wellbeing among medical oncology faculty. Conclusions: By leveraging technology and non-clinical staff workflows to improve the processing of insurance PAs of ambulatory intravenous chemotherapy, we aim to improve timeliness of quality care delivery to patients and clinical staff wellness. West CP et.al. Physician burnout: contributors, consequences and solutions. J Intern Med. Jun 2018;283(6):516-529. Lin NU et al. Increasing Burden of Prior Authorizations in the Delivery of Oncology Care in the United States. J Oncol Pract. Sep 2018;14(9):525-528.
Acute care utilization at the end of life: Does race/ethnicity matter?
Authors: Gladys M. Rodriguez, Lisa G. Rosas, Manali I. Patel
Journal: Journal of Clinical Oncology (2022)

189 Background: Lung cancer is the leading cause of US cancer deaths. Providing high quality care near end-of-life (EOL) is critical. Hispanic and Black patients with cancer receive less palliative and hospice care referrals and have less knowledge of advance directives compared to non-Hispanic Whites. While it is posited that such inequities can result in disparities in acute care use and goal-discordant care at the EOL among racial/ethnic minority populations, few studies have evaluated whether acute care utilization at the EOL for patients with lung cancer differs by race/ethnicity. Methods: Adult patients with a lung cancer diagnosis who died between 2005-2019 were identified in the California Cancer Registry database linked to a hospital discharge abstracts from the Office of Statewide Health Planning and Development. ICD9/10 codes were used to identify aggressive EOL care defined as: hospital/ED visit, death, intubation, CPR, and dialysis within 14-days of death. Logistic regression models estimated the odds of such care by race and ethnicity. Models were adjusted in apriori considerations of age, income, socioeconomic status, insurance, geography, histology, stage, comorbidities, and care receipt at NCI-designated hospitals. Results: Among 207,429 patients included, mean age was 74 years, 51% were male, 83.6% lived in urban areas, 28% had income 200% below Federal Poverty Level, 48.8% had Medicare, 91.8% received care in a non-NCI designated cancer center and 48.3% had stage IV disease. Black, Hispanic and Asian/Pacific Islander patients compared to Non-Hispanic Whites had increased odds of aggressive EOL care (See Table). Conclusions: This study demonstrates disparities in acute care use and aggressive care delivery among racial and ethnic minorities with lung cancer at the EOL. Solutions are urgently needed to reduce such disparities in care.[Table: see text]